Elgenidy Anas, Amin Mostafa Atef, Awad Ahmed K, Emad Abdullah, Nassar Abdelrahman, Alomari Omar, Ibrahim Radwa, Husain-Syed Faeq, Aly Mostafa G
Faculty of Medicine, Cairo University, Cairo, Egypt.
Faculty of Medicine, Ain-Shams University, Cairo, Egypt.
Hemodial Int. 2024 Apr;28(2):148-161. doi: 10.1111/hdi.13141. Epub 2024 Feb 27.
Determining dry weight is crucial for optimizing hemodialysis, influencing efficacy, cardiovascular outcomes, and overall survival. Traditional clinical assessment methods for dry weight, relying on factors such as blood pressure and edema, frequently lack reliability. Lung ultrasound stands out as a promising tool for assessing volume status, given its non-invasiveness and reproducibility. This study aims to explore the role of Lung ultrasound in evaluating the impact of hemodialysis and ultrafiltration on extravascular lung water, with a specific focus on changes in B-lines post-hemodialysis compared to pre-hemodialysis.
The research encompassed searches across PubMed, WOS, and Scopus databases for studies related to lung ultrasound and hemodialysis. A meta-analysis was then performed to determine the mean differences in various parameters before compared to after, hemodialysis, including the number of B-lines, indexed end-inspiratory and end-expiratory inferior vena cava diameters, inferior vena cava collapsibility index, weight, blood pressure, and serum levels of NT-pro-BNP.
Our meta-analysis, included 33 studies with 2301 hemodialysis patients, revealed a significant decrease in the number of B-lines post-hemodialysis (mean difference = 8.30, 95% CI [3.55 to 13.05]). Furthermore, there was a noteworthy reduction in inspiratory and expiratory inferior vena cava diameters post-hemodialysis (mean difference = 2.32, 95% CI [0.31 to 4.33]; mean difference = 4.05, 95% CI [2.44 to 5.65], respectively). Additionally, a significant positive correlation was observed between B-lines and the maximum inferior vena cava diameter both pre- and post-hemodialysis (correlation coefficient = 0.39; correlation coefficient = 0.32, respectively).
These findings indicate the effectiveness of lung ultrasound in detection of volume overload and assessment of response to ultrafiltration in hemodialysis patients.
确定干体重对于优化血液透析、影响疗效、心血管结局和总体生存率至关重要。传统的干体重临床评估方法依赖于血压和水肿等因素，往往缺乏可靠性。鉴于肺超声具有非侵入性和可重复性，它是评估容量状态的一种很有前景的工具。本研究旨在探讨肺超声在评估血液透析和超滤对血管外肺水的影响中的作用，特别关注血液透析后与透析前相比B线的变化。
该研究在PubMed、WOS和Scopus数据库中搜索与肺超声和血液透析相关的研究。然后进行荟萃分析，以确定血液透析前后各种参数的平均差异，包括B线数量、吸气末和呼气末下腔静脉直径、下腔静脉塌陷指数、体重、血压和NT-pro-BNP血清水平。
我们的荟萃分析纳入了33项研究，共2301例血液透析患者，结果显示血液透析后B线数量显著减少（平均差异=8.30，95%CI[3.55至13.05]）。此外，血液透析后吸气和呼气时的下腔静脉直径也有显著减小（平均差异分别为2.32，95%CI[0.31至4.33]；平均差异为4.05，95%CI[2.44至5.65]）。此外，血液透析前后B线与下腔静脉最大直径之间均观察到显著正相关（相关系数分别为0.39；0.32）。
这些发现表明肺超声在检测血液透析患者容量超负荷和评估超滤反应方面是有效的。
